DRUG TREATMENT PROGRAMS - DRUG COURT
Lenora's Final Project Outline: Drug Treatment Programs - Drug Court
Drug Treatment Programs
Drug Courts
Sociology 4380
Lenora Young
DRUG COURTS
Drug courts are popular tools in combating the issue of drug and alcohol abuse among adults and juveniles within the court system. A drug court is a specialized court-based program that targets criminal offenders and parents of juvenile offenders with pending child welfare cases who have alcohol and other drug addiction and dependency problems. The criminal justice system works cooperatively with treatment and other systems to provide an offender with the possible tools necessary to get into a recovery program, successfully complete recovery, and lead a productive life.
The first drug court was started in Dade County Circuit Court in the state of Florida in 1989. It was started to combat the rapidly increasing recidivism rates. The first drug courts were aimed at the adult population in a response to increasing crime rates and prison overcrowding. Adult drug courts were so successful in intervention and improvement of the lives of adult offenders, juvenile courts decided the drug court program could work for juvenile offenders as well. Juvenile drug courts have grown in popularity and now include family drug courts that deal primarily with abuse and neglect cases. Although adult drug courts vary from juvenile drug courts in their target population, program model and service resources, they are both generally based on a comprehensive model involving the following:
Research has shown that the stability of a drug court program plays a key role in successful case management and the reduction of an offender reoffending. Research also shows that no other intervention program can touch the results produced by drug courts. Over a decade of research has shown that drug courts significantly improve substance abuse treatment outcomes, reduce crime, and produce greater cost benefits than any other justice program.
Now, courts are operating or being planned in 50 States, the District of Columbia, Northern Mariana Islands, Puerto Rico, Guam, two Federal Districts, and more than 70 tribal locations. There are currently 2,147 drug courts operating within the United States. Missouri has 124 drug court programs in 115 counties serving more than 3,400 participants. The first drug court in Missouri was started by Circuit Judge David Dolan of Sikeston, Missouri. Since its inception, more than 6,200 people have graduated from a drug court in Missouri with a 10 percent recidivism rate. Unfortunately, across America, the completion rate remains low, ranging from 27% to 66%.
ELIGIBILITY
The first step towards treatment is to assess the eligibility of a candidate. The eligibility for drug treatment is decided by a drug court judge. They decide who is eligible to be admitted into their court program and most judges are very strict about the regulations and completion of the program by the offender.
Sometimes though, poor decisions are made regarding who is allowed into the program, thus resulting in the low completion rates mentioned above.
One key factor that is used to achieve more favorable completion rates among candidates is the use of objective, evidence-based screening and assessment instruments. Even though screening and assessment can be used interchangeably, they have different functions within the drug court system. Screening determines eligibility and typically takes place soon after the arrest of the offender. Assessment determines the type and level of services provided. Assessment usually occurs after the offender has been admitted into a drug court program.
The determining factors for admittance into a drug treatment program are drug use severity, mental health problems, motivation for treatment, and high risk offenders.
It is essential that individuals be screened for drug use severity. Research has demonstrated that intensive treatment services should be given to individuals with the most severe drug use history. If intensive services are given to individuals with less severe problems, it is seen as a waste of valuable resources.
It may also make their drug use problem worse. Drug courts also screen for mental health problems. By quickly identifying the potential existence of a mental health disorder, this enables the judge to assess the appropriate treatment service.
Motivation for treatment is a very important determining factor as well. When a person is faced with legal pressure to complete a program, they may not be as successful. If a person is truly motivated and really want to get help from their addiction, they are more likely to have a better outcome, thus successfully completing their treatment program.
Drug courts also take into consideration the offenders risk status. The court determines criminal risk by examining the type of offense committed and the offender's criminal history. This information is gathered by the use of a screening tool called the TCU Criminal Thinking Scale. It is a free instrument that examines entitlement, justification, power orientation, cold heartedness, criminal rationalization, and personal irresponsibility of an offender. If a drug dependent individual scores high on these scales, they are said to "think like a criminal" and therefore are said to be a threat to the public. They are then considered a good candidate for intensive drug court treatment designed to address both drug use and criminal behavior.
If the individual, and in juvenile cases the parents, all decide to proceed with the drug court process, then a case manager is assigned to the individual.
Case management is the coordination of care and services in order to help people better meet their needs and attain specific goals. A case manager takes on the important functions of assessment, planning, linking, monitoring, advocacy, and education that translate into the drug court system.
First there is the planning process. This is where goals to be completed during treatment are made. Linking requires the case manager to identify the needed resources for the offender to help them successfully complete the program. This includes a link to a probation officer, judge, counseling, educational outlets, job training, etc.
A case manager must also monitor the links to ensure that the participant is able to access the needed resources, the individual is respondent to the resources, and that the resources are helpful to the individual.
The major function of any drug court program is to provide "effective" treatment to an offender. The three appropriate goals of any addiction treatment are:
1. Elimination or reduction of alcohol and drug use. This is the most important goal of all substance abuse treatments.
2. Improve health and function of the individual.
3. Reduction in public health and public safety threats.
The above three goals form the basis of the expectations regarding the effectiveness of addiction treatment as it relates to a drug court situation. There are drawbacks to the above goals as well. Sometimes it may be difficult to achieve all three goals because of one reason or another. Some of those reasons are as follows:
TYPES OF THERAPY
Drug courts use different types of treatment to combat certain types of behavior. Relapse Prevention Therapy (RPT) is a cognitive-behavioral approach to the treatment of addictive behaviors. It focuses primarily on the nature of the relapse process and suggests strategies useful in coping and maintaining behavior change during drug treatment or while incarcerated.
RPT is based on the "feel good" idea that engaging in an addictive behavior helps to enhance pleasure and is self medication from physical or emotional pain. RPT views addictive behaviors from a psychosocial point of view. It reasons that biologically, psychoactive chemicals affect brain function and lessens a person's ability to experience pleasure normally. The only way they can experience pleasure is from a drug high. Psychologically, addictive behaviors result in distorted thinking, including denial and rationalization. It also preoccupies a person with the need to acquire and use drugs. Socially, addictive behaviors can interfere with interpersonal communication skills therefore causing conflict between the user and his/her family, friends, and society.
RPT is also used to prevent relapse by providing help coping with high risk scenarios. When RPT is used in special populations, techniques need to be reassessed for the unique needs of the individuals. The definition of a special population includes both young and elderly offenders, women in treatment, offenders with mental health problems, different ethnic groups, and multiple addictive behavior problems.
Medications used to help with treatment of drug and alcohol abuse have developed over the years and are provided to patients in drug treatment programs. Medications prescribed for reducing alcohol and drug abuse problems can prevent withdrawal, reduce post withdrawal, and induce an unpleasant physical effect of re-use of an addictive substance. But keep in mind that not all medications provide the desired results. However, for those medications that are successful, relapse rates are significantly low. Medications used during treatment are:
POSITIVE REINFORCEMENT IN DRUG COURT SYSTEMS
Positive reinforcement methods have recently received a great deal of attention because of their ability to promote sustained behavior changes while emphasizing a more supportive approach to treatment of substance abusers. The principle of positive reinforcement has been effectively integrated into the drug court system. The main idea is to show the individual the benefits of abstinence by providing immediate and tangible rewards. The original form of positive reinforcement was developed by Steve Higgins. Stephen Higgins, PhD, Professor of Psychiatry and Psychology at the University of Vermont, developed an incentive approach to treatment that used vouchers to reward cocaine treatment outpatients for meeting predetermined therapeutic targets. Every time a negative urine sample was submitted, the voucher could be used to purchase retail goods which were obtained by the clinic staff. The voucher system that Mr. Higgins developed worked well initially by engaging the patients in treatment longer and reducing their cocaine use. The flaw in the program however was the cost. When the program was introduced on a larger level, the cost became too much. In his initial study, patients qualifying for the maximum amount in vouchers and bonus points earned nearly $1,000. Average earnings among patients in this study were about half that amount, but that still represents a significant cost for the average treatment center.
Now, positive reinforcement is still used in drug courts, but on a much lower, cost effective basis.
Another form of positive reinforcement is praise from the judge. This is where positive reinforcement makes the biggest impact. Judges should deliver praise for any successes no matter how big or small.
SANCTIONS
Rewarding desired behavior is much more effective and efficient than punishing for undesired behavior. Unfortunately, some behaviors cannot be permitted to recur, therefore requiring the need of sanctions. When administered correctly and in combination with adequate treatment and positive reinforcement, sanctions can be effective tools at reducing substance use and crime. Also, clients should be clearly informed about the specific behaviors that constitute an infraction. But because sanctions may need to be individualized in some instances, it may not always be feasible to inform clients in advance about the precise sanctions that will be imposed for certain behaviors.
FUNDING FOR DRUG COURTS IN MISSOURI
The State of Missouri is widening link between drug courts and the Missouri Division of Alcohol and Drug Abuse. The Missouri Division of Alcohol and Drug Abuse have provided Medicaid and state funds to substance abuse treatment programs throughout the state. Most of the clients of drug court programs qualify for Medicaid or a reduced fee, which allows for state dollars to be used to service those clients. The primary funding source for drug court programs is through the Drug Courts Resources Fund which is administered by the Drug Courts Coordinating Commission. The commission is made up of four executive branch appointments from the Missouri Departments of Social Services, Corrections, Public Safety, and Mental Health. The Missouri General Assembly has provided revenue funding to the Resource Fund for several years. The funds can be used for treatment services within the drug court system.
American taxpayers would save more than $46 billion if drug addicts who are now in prison were instead treated for their addiction, according to a study released at a national convention of drug court professionals. There is a call out to lawmakers to increase funding to drug courts. "Most addicts need something more than being warehoused," said Judge Charles Simmons Jr., a drug court judge in Greenville, S.C. "Drug courts are putting families back together, and they are decreasing crime at a tremendous savings to taxpayers." Housing an inmate in prison can cost up to $40,000 a year while drug court treatment costs up to $3,500 per offender a year, Simmons said.
Drug courts offer light at the end of the tunnel for many substance abusers. The power of the drug court remains in improving lives and saving lives and families. Drug courts are highly effective and their use should not only be continued but funding and participation greatly increased.
BIBLIOGRAPHY
http://www.ojp.usdoj.gov/nij/topics/courts/drug-courts/welcome.htm
http://www.whitehousedrugpolicy.gov/enforce/drugcourt.html
Guide for Drug Court Screening and Assessment: http://www.ncjrs.gov/
Higgins, S.T. Addiction Professional (2006)
http://www.medicinenet.com/alcohol_abuse_and_alcoholism/page2.htm
http://www.breakthroughaddictionrecovery.com/content-page-93-FDA%20Approved%20Medications.html
http://www.nida.nih.gov/Infofacts/treatmeth.html
http://nationalpsychologist.com/articles/art_v9n5_3.htm
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